Dental Lab Hygiene: Microbes & Prevention

• Hand hygiene is a critical infection control practice, essential for protecting both patients and healthcare workers.

Introduction to Microbial Hazards

• Dental laboratories are prone to microbial contamination through patient material exposure.
• Common infection routes are direct contact, indirect transmission, airborne/droplet spread, and cross-contamination between workstations.

Common Microorganisms: Bacteria

• Streptococcus mutans causes dental caries, found in saliva and dental impressions.
• Mycobacterium tuberculosis causes tuberculosis, transmitted via aerosols and contaminated instruments.
• Staphylococcus aureus (MRSA) causes skin infections and pneumonia, present on contaminated hands and surfaces.

Common Microorganisms: Viruses

• Hepatitis B (HBV) and C (HCV) cause liver infections with high transmission risk via blood, saliva, and dental tools.
• Human Immunodeficiency Virus (HIV) weakens the immune system, transmittable through blood-contaminated materials.

Common Microorganisms: Fungi and Prions

• Candida albicans is a fungus causing oral and systemic infections, found on dentures and moist environments.
• Prions, causing Creutzfeldt-Jakob Disease (CJD), are neurodegenerative agents transmittable via contaminated dental instruments.

Types of Hand Hygiene

• Handwashing is highly effective at removing germs, dirt, and contaminants.
• Hand sanitizing provides a quick, convenient way to kill germs when soap and water are not available.
• Surgical hand antisepsis uses antiseptic solutions to reduce germs on hands before surgical procedures.

The Role of Hand Hygiene in Infection Prevention

• Basic Hygiene removes germs and prevents their spread.
• Pathogen control helps to stop the transmission of harmful microorganisms.
• Healthcare safety involves protecting patients and staff from infections.
• Interpersonal interactions reduce the spread of illnesses between people.

Importance of Hand Hygiene

• Hand hygiene is a cornerstone of infection prevention, reducing the risk of transmitting diseases.
• Healthcare professionals contribute to a safer environment and reduce healthcare-associated infections through hand hygiene.
• Hand minimizes hospital-acquired infections, which can lead to prolonged stays and increased costs.
• Effective hand hygiene protects patients and helps prevent the spread of infections in the community.

Handwashing Techniques

• Wet hands with clean, running water, either warm or cold.
• Apply enough soap to cover all hand surfaces thoroughly.
• Scrub hands for at least 20 seconds, cleaning all surfaces.

Common Misconceptions about Hand Hygiene

• Handwashing alone is insufficient for infection control.
• Alcohol-based hand rubs are not as effective as soap and water, depending on the situation.
• Wearing gloves does not eliminate the need for hand hygiene.
• Busy schedules can prevent consistent hand hygiene practices.

Pathogen Transmission in Healthcare Settings

• Close contact between patients and staff increases infection risk.
• Lack of hand hygiene and contaminated surfaces/equipment enable pathogen spread.
• Common routes: Airborne, droplet, and contact in hospitals and clinics.

The Five Moments for Hand Hygiene

• Before touching a patient, wash hands to protect the patient by not introducing germs.
• Before an aseptic task, wash hands to prevent infection by preventing patient contamination.
• After body fluid exposure, wash hands to protect yourself and others.
• After touching a patient, wash hands to protect yourself and the surrounding environment.
• After touching patient surroundings, wash hands to protect the environment.
• These moments interrupt transmission of pathogens and prevent healthcare associated infections.

Before Patient Contact

• Washing hands before touching a patient reduces the risk of germ transmission.
• This ensures that harmful microbes are not introduced to the patient.
• Hand hygiene is vital for infection control in healthcare settings.
• Effective hand hygiene prioritizes patient safety.

Before Aseptic Tasks

• Washing hands is crucial before procedures involving sterile equipment or invasive actions.
• This helps prevent microorganisms from entering the sterile field.
• The risk of infection for the patient is reduced, and a sterile environment is maintained.

After Body Fluid Exposure

• Hand hygiene is vital after exposure to bodily fluids like blood, urine, or feces.
• Washing removes risks, protecting healthcare staff and patients from infectious agents.

After Patient Contact

• Washing hands after touching a patient prevents germ spread to others or healthcare personnel.
• This is part of the daily routine for every healthcare worker.
• Demonstrates respect and commitment to patient safety and well-being.

After Contact with Patient Surroundings

• Bedrails: Frequent touch points that can harbor microbes.
• Medical Equipment: Germs transfer easily from equipment to hands.
• Tables and Chairs: Surfaces touched by multiple people may be contaminated.

Proper Hand Hygiene Techniques

• For soap and water: wet hands, apply soap, rub for at least 20 seconds, rinse thoroughly, and dry with a clean towel.
• Apply sufficient hand sanitizer, covering all surfaces, and rub until dry.
• Ensure all hand surfaces are covered.

Hand Washing

• Wet hands under running water.
• Apply soap and lather well.
• Scrub hands for at least 20 seconds.
• Rinse thoroughly to remove all soap.
• Dry hands using a single-use towel.
• Handwashing effectively reduces infections by eliminating harmful microorganisms.

Hand Sanitizing

• Hand sanitizing is effective when soap and water are unavailable.
• Dispense enough hand sanitizer to cover all hand surfaces.
• Rub hands, ensuring all areas are covered.
• Allow to dry without touching objects.
• Hand sanitizer should not replace handwashing if hands are visibly soiled.

Handwashing vs. Alcohol-based Hand Rubs

• Handwashing removes visible contaminants, requires soap and water.
• Alcohol-based rubs quickly kill microbes without water, are more convenient and accessible.

Barriers to Effective Hand Hygiene Practices

• Lack of Time: Busy schedules can make it difficult to commit to hand washing opportunities.
• Inconvenient Access: Sinks/sanitizers may not be easily located.
• Skin Irritation: Frequent washing can cause dryness/cracked skin.
• Forgetfulness: Workers may forget hand hygiene routines.

Importance of Hand Hygiene Education and Training

• Skill Development: Teaches good hand hygiene techniques.
• Increased Awareness: Highlights the critical role of hand hygiene.
• Behavior Modification: Encourages regular hand hygiene practices.

Hand Hygiene During Emergencies and Outbreaks

• Escalate Protocols by enforcing strict hand hygiene procedures.
• Address Supply Shortages, ensuring sanitizers, water, and soap and easily available.
• Educate Continuously through ongoing staff/patient training.
• Monitor Vigilantly, tracking compliance and responding to any change.

Infection Control

• It is the practice of preventing the spread of infectious diseases in healthcare settings and beyond.
• It includes policies and procedures protecting patients, staff, and visitors from microorganisms.

Importance of Infection Control

• Patient Safety: Protects patients from infections, promoting well-being.
• Staff Safety: Minimizes the risk of healthcare workers contracting infections.
• Resource Conservation: Reduces healthcare costs associated with treating infections.
• Public Health: Prevents the spread of infectious diseases within the community.

Chain of Infection

• The chain of infection shows how infection spreads, each link representing a step that can be broken to stop the spread.
• The key components or links are: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
• There are six links and these are interconnected. If one link is broken, infection spread stops. Understanding these links helps develop strategies

Infectious Agents

• These are the root cause of infections
• Examples include bacteria, viruses, and fungi.

Reservoirs

• This is where pathogens live to make more pathogens
• Can reside in humans, in animals, or on surfaces
• Controlling these helps reduce the spread and is done through sanitation
• Humans can be carriers without showing symptoms.
• Animals, like pets and livestock, can also harbor pathogens.
• Surfaces, such as doorknobs and tables, can also act as reservoirs.

Portal of Exit

• Allows pathogens to leave a host.
• Respiratory droplets and blood are common examples.
• Proper waste disposal and covering coughs are important preventative measures.
• Respiratory tract: Coughing and sneezing spread droplets.
• Blood: Invasive procedures may spread bloodborne pathogens.
• Gastrointestinal tract: Feces can transmit pathogens.

Mode of Transmission

• Refers to how pathogens are spread.
• Transmission can be either direct or indirect.
• Direct Transmission: Includes touchingor droplet spread.
• Indirect Transmission: Involves contaminated surfaces or vectors.
• Other modes are Airborne and Vector.

Portal of Entry

• Allows pathogens to enter a host.
• Mucous membranes or broken skin are common entry points.
• Practice good hygiene to prevent the spread

Susceptible Host

• Susceptibility depends on immunity and health.
• Immunocompromised individuals are at higher risk.
• Preventative care: Vaccination and healthy habits can help build resistance to disease.
• Factors: Age, health status and immunity

Standard Precautions

• A set of infection control practices that apply to all patients, regardless of infection status.
• Principles:
• Hand Hygiene: Washing hands frequently with soap and water or using an alcohol-based hand rub.
• Personal Protective Equipment (PPE): Wearing appropriate PPE, such as gloves, gowns, masks, and eye protection.
• Environmental Cleaning and Disinfection: Maintaining a clean and disinfected environment to reduce germs.
• Safe Injection Practices: Following proper procedures for administering injections to prevent needlestick injuries.

Personal Protective Equipment (PPE)

• Specialized clothing or gear that protects healthcare workers from infectious agents and bodily fluids.
• Examples include gloves, gowns, masks, and eye/face protection.
• Proper Use of PPE:
  • Donning: Put on PPE in a specific order.
  • Doffing: Take off PPE in a specific order to prevent self-contamination.
  • Disposal: Discard PPE properly in accordance to guidelines

Respiratory Hygiene and Cough Etiquette

• Respiratory hygiene practices help prevent the spread of respiratory infections through coughs and sneezes.

Sharps Safety

• Sharps safety practices reduces needlestick injuries and ensure proper disposal.

Environmental Cleaning and Disinfection

• It is crucial for removing infectious microorganism from surfaces and equipment
• Involves removing visible dirt and debris with chemical agents.

Handling Textiles and Laundry

• It should include proper handling and disposable to prevent infection transmission

Transmission-Based Precautions; Contact, Droplet and Airborne

• In addition to standard precautions, transmission-based precautions are used when a patient is known or suspected to have a specific infectious disease.
• Contact precautions are for patients with, or suspected of having, infections that can spread by direct or indirect contact.
• Droplet precautions are for patients with infections that spread through respiratory droplets produced during coughing, sneezing, talking, or suctioning.
• Airborne precautions are used for patients with infections that spread through airborne droplets or particles that can remain suspended in the air for longer periods.

Outbreak Management

• A coordinated response to a cluster of infections in a specific population or location.
• Involves a coordinated response to a cluster of infections in a specific population or location.

Immunization and Screening

• These programs help significantly by preventing the occurrence or spread of infectious diseases

Waste Management

• Waste management practices helps avoid contamination with safe disposal of various types of infections

Occupational Health and Safety

• Programs that help with preventing health care workers from infection or other hazards

Exposure Prevention and Post Exposure Management

• Healthcare workers must be aware of exposure risks and follow established protocols for post-exposure management.

PPE in Healthcare Settings

• Using PPE aims to improve personnel safety, reduce occupational risks, and promote compliance with best practices.
• PPE creates a barrier between the user and potential hazards, like infectious materials.
• PPE is a vital part of protection for healthcare staff and patients from the spread of infectious diseases.
• Healthcare workers are expected to use PPE when in contact with patients or contaminated materials to reduce the risk of exposure.

PPE Types

• Common examples of PPE include gloves, gowns, plastic aprons, masks, face shields, and eye protection.

Factors that Influence PPE Selection

• Type of exposure
• Durability and suitability
• Fit

Gloves

• Gloves prevent the transfer of microorganisms, protect hands from hazardous materials and contaminated surfaces.
• Medical, Non-medical, and Surgical gloves are different types that are used in healthcare.
• Gloves may be sterile or non-sterile depending on the task.
• Sterile versions are required for surgical procedures.
• Sterile gloves are needed in surgical scenarios, non-sterile for general patient care.
• Vinyl, latex, and nitrile are common materials and selecting the correct material depends on costs, durability, and potential allergies.
• Latex provides great sensitivity and dexterity but can cause allergies.
• Nitrile is a good alternative to latex, providing excellent barrier protection and puncture resistance.
• Chloroprene gloves are used for handling certain hazardous materials offer superior chemical resistance.
• Work from "clean to dirty" when using gloves, and change them when they are torn or heavily soiled.
• Change gloves after each patient.
• Washing or reusing disposable gloves, touching your face, and adjusting PPE with contaminated gloves must be avoided.

Gowns and Aprons

• Protect healthcare workers from blood, body fluids & infectious materials.
• Gowns and aprons can be made of natural or synthetic materials and are available in reusable or disposable models.
• Donning, proper use, and removal of gowns is important for worker and patient safety.

Face Masks

• Protects the nose and mouth from sprays, splashes and fluid penetration.
• Face shields are for the eyes, nose, and mouth from exposure to splashes, sprays, and respiratory droplets.
• Eye protection, such as goggles, must fit snugly around the eyes to create a barrier.
• Face shields, cleaned per manufacturer's instructions, can be reused if appropriate.
• Proper donning of eye and face protection helps protect from splashes, sprays, and airborne contaminants.
• Goggles are used to protect the eyes from splashes, sprays and other hazards.
• Respiratory devices, such as particulate, elastomeric, or PAPRs, protect from inhaling infectious aerosols.

Donning and Doffing PPE

• Don PPE in the following order: gown first, then mask or respirator, goggles or face shield, and gloves last.
• Remove PPE in this order: gloves first, then face shield or goggles, gown, and mask or respirator.
• Remove PPE at the doorway or immediately outside the patient's room to avoid contamination.
• Washing hands or properly sanitizing them after the PPE is off is critical.
• Begin by unfastening the Isolation gown, ensure the outside of the gown is turned inward to prevent potential contaminants and then discard in appropriate container.

General PPE Guidelines and Considerations

• Always don PPE before patient contact to prevent contamination.
• The gown is donned first to create a barrier against contamination.
• A mask or respirator protects nose and mouth from exposure.
• Goggles or a face shield protect the eyes from splashes or sprays.
• Gloves are donned last to protect hands and prevent spread of contaminants.
• The outside front of PPE is considered contaminated.
• A selection of the correct glove type and size, should always be selected before the donning of any equipment.
• In the PPE sequence, gloves should be donned after the isolation gown.
• Ensure that the face masks fully cover the nose and mouth creating a seal to prevent infectious diseases
• To properly don a gown, first select the appropriate type and size.
• Effectively donning a face mask is significant in preventing pathogens

Additional PPE Challenges and Considerations

• Different medical procedures require different levels of protection
• Extended use of PPE use can lead to physical discomfort and fatigue, affecting performance and well-being.
• PPE sustained use can contribute to stress, anxiety, and burnout.
• The first step in properly donning gloves is to select the correct glove type and size.
• Removing gloves properly is crucial to prevent the spread of germs and contamination.
• To safely remove a face mask, start by untying the bottom tie, then the top tie.
• When removing a particulate respirator, avoid contamination.